HomeMy WebLinkAbout982621.tiff OIL AND GAS DIVISION ORDER
OPERATOR: HS RESOURCES, INC.
8
1999 BROADWAY, SUITE 3600 Date: 12/t Effective Date: Date o
f First Production
DENVER, CO 80202
(303)296-3600 WeellllNumber:
o 980560
Well Name:ti HSRT2N, Magness#11-6A. 6: S COPY
Description: T2N, R66W,Sec. 6: S/2
Formation: J Sand
County and State: Weld, Colorado
Owner SEE EXHIBIT'A'ATTACHED HERETO AND MADE A PART HEREOF
Decimal Interest: SEE EXHIBIT'A'ATTACHED HERETO AND MADE A PART HEREOF
The undersigned certifies the ownership of the decimal interest in production or proceeds as described above payable by HS RESOURCES,INC.
The undersigned agrees to notify HS RESOURCES, INC., in writing, of any change in ownership, decimal interest, or payment address. All such
changes shall be effective the first day of the month following receipt of such notice.
HS RESOURCES, INC. is authorized to withhold payment pending resolution of a title dispute or adverse claim asserted regarding the interest in
production claimed herein by the undersigned. The undersigned agrees to indemnify and reimburse HS RESOURCES, INC.any amount attributable to
an interest to which the undersigned is not entitled.
HS RESOURCES, INC. may accrue proceeds until the total amount equals twenty-five dollars ($25.00), or pay annually, whichever occurs first, or as
required by applicable state statute.
This Division Order does not amend any lease or operating agreement between the undersigned and the lessee or operator or any other contracts for
the purchase of oil or gas.
In addition to the terms and conditions of this Division Order, the undersigned and HS RESOURCES, INC. may have certain statutory rights under the
laws of the state in which the property is located.
The undersigned authorizes HS RESOURCES, INC.to withhold from the proceeds of any and all production referred to herein the amount of any tax
placed thereon by any governmental authority and to pay the same on our behalf.
WI s/. 4. ai, fE� lC�
Owner(s)Signature(s): a'$ j,/ xi�U ���� / �)
� � 2L�iirrj S4✓�?'/
Constance L. Harbert ; r 7� '( �` 5
Chair, Weld County Board of Deputy Clerk to ,T .ar ?!Ln �-
Commissioners ) ' rI
Owner(s)S.S. or Tax I.D.# 84-6000-813
Owner Daytime Telephone# (970)356-4000
Owner Fax Telephone# (970)356-0242
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number.
Failure to comply will result in 31%tax withholding and will not be refundable by Payor.
IIIIII IIIIIII III IIIII IIII IIII 2659433 12/10/1998 09:43R Weld County CO
1 of 3 R 0.00 D 0.00 JR Suki Tsukamoto
982621
LE00 ;1
.... 1 I
a) F a. , 6 a a a a a a
N' b N I a) tll tl) N
U U U U U U I U U
l0 Cu Cuco Cu N A Cu
CO CO W W CO CO. CO 0
V V V I V V 1: V
N N Nr. N N
'CND CO CO CO CO CO Cr) th I
mi
a Co cri CO C
O r — co- rcr) x in N
y 'a X X xX X X
x x
0 U:
K
S. � N _N N N N N NI
N _
x X ' X X i X X X
Xi 2— —
2 I2- - 2 CO co O 1
I U 10 U) a
X X X X
CO M O. 0
N
. .__ --. J___—.
O O O 0 O O O O
N ) V CO W N. co
N COco m CO Tr
O CO O
N M O V V 4 r
CO
O)
N w O Or O O O O O O
E d 00 06 o d 0 0
US 0 C
0 ,
_.._.i ,.. 1 -. -_— - ___. ,. -__—. —_-
coco co
co
co _
� •0 2 N N O « N N 2 CO OiN
mI N Oii I V N O C 7 01 '1OO 'co O'^
Fa M v m� s co m. � N ,� m �lro
< N O d ro, 0 0 m m i � L.� m 0 � CO cal o
W 3 c .c o 0 o t 0 V ° o 'a o x O
CO >; 2 a 0 o. o
j N
inr O m E N V N N J CV J_1
CO• dCJ o N W o c O c 0 2 m C a CN O
- W N m Z J M 0 Cr) o u_ r01 L.L. d ❑
b
C
N
C I
N
C
O O C
Q O
O) c C C
I0 E .c v m
m m I
-i 2
I
0 wQ.
CO d 0
10 O O C J N C
Ic a 2 , o) I _1 E �;
'� m olzt m Q I� m' c m
to cCO
° m
cd Z Li) Oct at co Y' m4'
3 No C) y co 0 CN
I.L. C T
o W U' _1 u_ Lu H Y w cc
Q
O_
•
N w
N N C co
m tc3O N o O O I
m Co co Q LL.co 2
i0 C N M M M O co 7 N NO
N N a) N O N 3 --1 - z 0 0 Z Z Z
F. u) «)2 —) 3 o 21 m 1 _1, - 12 I O; I I Y I Y
Ir
IIIIII 11111 IIIIII IIII 11111 IIIII 1111111 III III Iil! III
2659433 12/10/1998 09:43A Weld County CO
2 of 3 R 0.00 D 0.00 JA Suki Tsukamoto 9q69411
111 11 1 I
e r' cC fm 1
1-- � 'U0 0' O I� Z
m'cc. _, _ . lw 1._,-y -...
H 0, u ui
w, m.
a v a' co'
,
co; C M Im I I
N I O ,O Cl
I W co, co co
0 x to r N
CO 1 XI
x x M1
3 to
V N EC
n in
EC1
m x x, L i1
U x' cc K IN-
_ I9
o 0 I 0
I N I Ir
r I Oi 1 10
1 1
'
I 1
1
0in O 0 0 10
O COO
1.1
O O, I di O O O r
C ,
1
I 1 1
1
o
'C
O E-
r I I�
n=10 r
FM OQ 1 Ij N
: 00 i 1 T ,
F 0\ L Nm !M N
0 "0
CO m
lo
!...2Q N O N V I i t N 1 N
ct U mic
W 1 N O x X
of
o m' O;2 1 m v;1
U) a
to N IN C N
To
rniC7 co 10
1
i I i
!
1 1
1 i
c: , I
0 I T'
o o I
a
E to U1
U U 1
N
E 1 8
o J 1
I IS].73
1 2 I C N 11 C C
0 1 I N I 1 N
el m al 1 y tt in 1
E' m, u w I
z 0 o' I o I m oo of
IiiiU N a w w
c a Io 0
m Im co
O �I 2 _- - _ ' D E 2,2
n <n I
1 1
I.
d
E, 1
0
z 0 N1
v o
F U ' CCo 1 1
3 Q Z
2 D,
111111 IIIII 111111 III 11111 IIIII 1111111 III 11111 1111 1111
2659433 12/10/1998 09:43A Weld County CO (yoU 9i/
3 of 3 R 0.00 D 0.00 JR Sukl Tsukamoto
COUNTY ATTORNEY
STAFF APPROVAL
This is to affirm the attached
Division Order or Authorization to
Receive Payment for an Oil and
Gas Well has been reviewed by
the County Attorney's staff as to
form, legal description, and
percentage of royalties, if
applicable.
i
ounty AAtt rney
DATE: -7
9qt)09Ce
tCLD COUNTY
crft
HS RESOURCES, INC. -
1999 BROADWAY, SUITE 3600 lai'? ETC -3
AN DENVER, COLORADO 80202 2
(303) 296-3600
FACSIMILE (303) 296-3601 CLERK
TO THE EO",^
December 1, 1998
TO: Interest Owners
HSR-Magness 11-6A, T2N-R66W,Sec.6: S/2
Weld Co., CO
Enclosed is a Division Order(in duplicate)for your interest in the captioned well. Please execute it in the following manner:
Be sure that your interest is correct.
Sign your name as it appears typewritten in the space provided in the presence of two witnesses.
If your social security number or tax identification number is not shown, please provide the number. Failure to provide
the number may result in a 20% withholding of your production proceeds, as required by law, and you also could be subject to a
penalty imposed by the Internal Revenue Service.
Please fill in your daytime phone number and fax number if any.
Verify that your mailing address is correct. If it is incorrect, please note your correct address.
If the interest is owned by a corporation, the Division Order must be signed by a duly authorized officer and attested. The
corporate seal must be affixed and the title of the signing officer shown.
If the interest is owned by a partnership, the Division Order must be signed by the general partner or managing partner and
evidence of such authority to sign must be furnished.
If the Division Order is signed by anyone other than the named owner, such as an agent, attorney-in-fact or guardian, evidence
of authority must be provided.
After you have completed and signed the Division Order, please return the original to us. The copy is for your records.
If you see a name on Exhibit "A" with "Address Unknown" in the address portion and happen to know the address or
phone number of that owner, please advise us.
Should you have any questions, please do not hesitate to call.
Yours truly,
HS RESOURCES,INC.
/d L pt s
Wendy L.Hopkins
Sr. Division Order Analyst
/wlh
ends.
9U09(1
Hello